Provider Demographics
NPI:1831387455
Name:SHIER FAMILY CHIROPRACTIC LLC
Entity type:Organization
Organization Name:SHIER FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SHIER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-821-0071
Mailing Address - Street 1:211 CORPORATE DR
Mailing Address - Street 2:SUITE H
Mailing Address - City:BEAVER DAM
Mailing Address - State:WI
Mailing Address - Zip Code:53916-3119
Mailing Address - Country:US
Mailing Address - Phone:920-821-0071
Mailing Address - Fax:920-821-0072
Practice Address - Street 1:211 CORPORATE DR
Practice Address - Street 2:SUITE H
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916-3119
Practice Address - Country:US
Practice Address - Phone:920-821-0071
Practice Address - Fax:920-821-0072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4138-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1518989631OtherNPI PROVIDER NUMBER
WI39004500Medicaid
WI000035837Medicare Oscar/Certification
WI39004500Medicaid